Promotion of higher order of cognition in undergraduate medical students using case-based approach

BACKGROUND The curriculum of pathology is conventionally "taught" in a series of didactic lectures, which promotes learning by rote. In this study, case-based learning (CBL) was introduced to assess its effect on higher order cognition and problem-solving skills in undergraduate medical students. SUBJECTS AND METHODS The prescribed syllabus of hepatobiliary system was delivered to the undergraduate medical students of the fourth semester by conventional didactic lectures. A pretest, which contained questions designed to test both analysis and recall, was administered, followed by CBL sessions, in the presence of a facilitator, encouraging active discussion among students. Students were then assessed using a similar posttest. The perceptions of the students and the faculty were gathered by means of feedback questionnaires. The scores obtained by the students in the pre- and post-test were compared by paired t-test. RESULTS Eighty-one students participated in CBL sessions, with 95.06% expressing a desire for more such sessions, preferably in all the topics. The faculty members also felt that CBL would be beneficial for the students but opined that it should be restricted to some topics. CBL was found to cause a highly significant (P < 0.0001) improvement in the students' higher levels of cognition, whereas the lower orders of cognition remained unaffected (P = 0.2048). CONCLUSIONS CBL promotes active learning and helps in the development of critical thinking and analysis in undergraduate medical students. Although it is resource-intensive, an attempt should be made to incorporate it along with lectures in clinically important topics.